El cuidado crítico en el paciente con COVID-19.

Critical care in the patient with COVID-19.

Contenido principal del artículo

Carmelo Dueñas Castel
Guillermo Ortiz Ruiz
Manuel Garay Fernández

Resumen

A comienzos de la pandemia se planteó que la mortalidad se relacionaba de forma inversa con la disponibilidad de recursos sanitarios. Debido a esto se buscó expandir las camas de cuidado intensivo y el número de ventiladores disponibles antes del pico. Si bien tal conducta ha sido cuestionada, está claro que resulta fundamental contar con una herramienta que permita seleccionar a los pacientes que requieren manejo en UCI, con base en una predicción de morbimortalidad. Por tratarse de una neumonía, en la gran mayoría de los casos, los lineamientos del Ministerio de Salud y el consenso de la Asociación Colombiana de Infectología (ACIN) propusieron los criterios de la American Thoracic Society (ATS) del 2007. Así, la presencia de un criterio mayor o tres criterios menores justificarían el ingreso a UCI.

Detalles del artículo

Biografía del autor/a (VER)

Carmelo Dueñas Castel, Asociación Colombiana de Neumología y Cirugía de Tórax

Médico especialista en Medicina Interna y Neumología, miembro del Comité de Cuidado Crítico de la Asociación Colombiana de Neumología.

Guillermo Ortiz Ruiz, Asociación Colombiana de Neumología y Cirugía de Tórax

Médico especialista en Medicina Interna y Neumología, miembro del Comité de Cuidado Crítico de la Asociación Colombiana de Neumología.

Manuel Garay Fernández, Asociación Colombiana de Neumología y Cirugía de Tórax

Médico especialista en Medicina Interna y Neumología, miembro del Comité de Cuidado Crítico de la Asociación Colombiana de Neumología.

Referencias (VER)

Accini JL, Beltrán N, Nieto VH, Ramos E, Pizarro C, Rebolledo CE, et al. Declaración de consenso en medicina crítica para la atención multidisciplinaria del paciente con sospecha o confirmación diagnóstica de COVID-19. Acta Colomb Cuid Intensivo. 2020.20;4:287-333. doi: 10.1016/j. acci.2020.04.003.

Jibaja M, Ortiz-Ruiz G, García F, Garay-Fernández M, Montelongo F, Martínez J, et al. Hospital mortality and effect of adjusting PaO2/FiO2 according to altitude above the sea level in acclimatized patients undergoing invasive mechanical ventilation. A multicenter study. Arch Bronconeumol. 2020;56(4):218-24. doi: 10.1016/j.arbres.2019.06.024.

Saavedra CH. Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-CoV-2/COVID-19 en establecimientos de atención de la salud. Recomendaciones basadas en consenso de expertos e informadas en la evidencia. Rev Asoc Colomb Infectol. 2020;24(3). doi: 10.22354/in.v24i3.851.

Siemieniuk RAC, Chu DK, Kim LHY, Güell-Rous MR, Alhazzani W, Soccal PM, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169. doi: 10.1136/bmj.k4169.

Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020;46:854-87. doi: 10.1007/s00134-020-06022-5.

Bhimraj A, Morgan RL, Shumaker AH, Lavergne V, Baden L, Cheng VC, et al. Infectious diseases Society of America Guidelines on the treatment and management of patients with COVID-19. Clin Infect Dis. 2020:ciaa478. doi: 10.1093/cid/ciaa478.

Fragkou PC, Belhadi D, Peiffer-Smadja N, Moschopoulos CD, Lescure FX, Janocha H, Karofylakis E, Yazdanpanah Y, Mentré F, Skevaki C, Laouénan C, Tsiodras S; ESCMID Study Group for Respiratory Viruses. Review of trials currently testing treatment and prevention of COVID-19. Clin Microbiol Infect. 2020 Aug;26(8):988-98. doi: 10.1016/j.cmi.2020.05.019.

Murthy S, Gomersall CD, Fowler RA. Care for critically ill patients with COVID-19. JAMA. 2020;323(15):1499-500. doi: 10.1001/jama.2020.3633.

Siemieniuk RA, Bartoszko JJ, Ge L, Zeraatkar D, Izcovich A, Kum E, et al. Drug treatments for covid-19: living systematic review and network meta-analysis. BMJ. 2020;370:m2980.doi: 10.1136/bmj.m2980.

WHO Solidarity Trial Consortium, Pan H, Peto R, HenaoRestrepo AM, Preziosi MP, Sathiyamoorthy V, et al. Repurposed antiviral drugs for Covid-19 - Interim WHO Solidarity Trial Results. N Engl J Med. 2020:NEJMoa2023184. doi: 10.1056/NEJMoa2023184.

RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid-19 - Preliminary report. N Engl J Med. 2020:NEJMoa2021436. doi: 10.1056/NEJMoa2021436.

Ji Y, Ma Z, Peppelenboshch M, Pan Q. Potential association between COVID-19 mortatlity and health-care resource availability. Lancet Glob Health. 2020;04;8:e48. doi: 10.1016/S2214-109X(20)30068-1.

Ministerio de Salud y Protección Social. Lineamientos para el manejo clínico de pacientes con infección por nuevo coronavirus COVID 19. 2020. Disponible en: https://www.minsalud.gov.co/Ministerio/Institucional/Procesos%20y%20procedimientos/PSSS03.pdf

Douglas WW, Rehder K, Beynen FM, Sessler AD, Marsh HM. Improved oxygenation in patients with acute respiratory failure: the prone position. Am Rev Respir Dis. 1977;115(4):559-66. doi: 10.1164/arrd.1977.115.4.559.

Gattinoni L, Busana M, Giosa L, Macrì MM, Quintel M. Prone positioning in acute respiratory distress syndrome. Semin Respir Crit Care Med. 2019;40(1):94-100. doi: 10.1055/s0039-1685180.

Scaravilli V, Grasselli G, Castagna L, Zanella A, Isgrò S, Lucchini A, et al. Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study. J Crit Care. 2015;30(6):1390-4. doi: 10.1016/j.jcrc.2015.07.008.

Ding L, Wang L, Ma W, He H. Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study. Crit Care. 2020;24:28. doi: 10.1186/s13054-020-2738-5.

Koeckerling D, Barker J, Mudalige NL, Oyefeso O, Pan D, Pareek M, et al. Awake prone positioning in COVID-19. Thorax. 2020;75:833-4. doi: 10.1136/thoraxjnl-2020-215133.

Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet. 2020;395:1225-8. doi: 10.1016/S0140-6736(20)30627-9.

Li JL, Fink JB, Ehrmann S: High-flow nasal cannula for COVID-19 patients: low risk of bio-aerosol dispersion. Eur Respir J. 2020;55(5):2000892. doi: 10.1183/13993003.00892-2020.

Winck JC, Ambrosino N. COVID-19 pandemic and non-invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems. Pulmonology. 2020;26(4):213-20. doi: 10.1016/j.pulmoe.2020.04.013.

Agarwal A, Basmaji J, Muttalib F, Granton D. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth. 2020;67(9):1217-48. doi: 10.1007/s12630-020-01740-2.

Ricard JD, Roca O, Lemiale V, Corley A, Braunlich J, Jones P, et al. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med. 2020;46(12):2238-47. doi:10.1007/s00134-020-06228-7.

Raoof S, Nava S, Carpati C, Hill NS. High-flow, noninvasive ventilation and awake (nonintubation) proning in patients with coronavirus disease 2019 with respiratory failure. Chest. 2020;158(5):1992-2002. doi: 10.1016/j.chest.2020.07.013.

Wunsch H. Mechanical ventilation in COVID-19: Interpreting the current epidemiology. Am J Respir Crit Care Med. 2020;202(1):1-4. doi: 10.1164/rccm.202004-1385ED.

Tobin MJ, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Ann Intensive Care. 2020;10(1):78. doi: 10.1186/s13613-020-00692-6.

Gattinoni L, Marini JJ, Busana M, Chiumello D, Camporota L. Spontaneous breathing, transpulmonary pressure and mathematical trickery. Ann Intensive Care. 2020;10:88. doi: 10.1186/s13613-020-00708-1.

Hernandez-Romieu AC, Adelman MW, Hockstein MA, Robichaux CJ, Edwards JA, Fazio JC, et al. Timing of intubation and mortality among critically ill coronavirus disease 2019 patients: A single-center cohort study. Crit Care Med. 2020;48(11):e1045-53. doi: 10.1097/CCM.0000000000004600.

Zuo MZ, Huang YG, Ma WH, Xue ZG, Zhang JQ, Gong YH, et al. Expert recommendations for tracheal intubation in critically ill patients with noval coronavirus disease 2019. Chin Med Sci J. 2020;35(2):105-9. doi: 10.24920/003724.

Meng L, Qiu H, Wan L, Ai Y, Xue Z, Guo Q, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience. Anesthesiology. 2020;132(6):1317-32. doi: 10.1097/ALN.0000000000003296.

Sorbello M, El-Boghdadly K, Di Giacinto I, Cataldo R. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia. 2020;75(6):724-32. doi: 10.1111/anae.15049.

Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with covid-19. Anaesthesia. 2020;75:785-99. doi: 10.1111/anae.15054.

Ortiz-Ruiz G, Dueñas-Castell C, Garay-Fernandez M, LaraGarcia A, Varón F, et al. Consenso colombiano de síndrome de dificultad respiratoria aguda (SDRA) «Documento de Rionegro 2019». Acta Colomb Cuid Intensivo. 2020;20:200-52. doi: 10.1016/j.acci.2020.03.001.

Ely EW. The ABCDEF bundle: science and philosophy of how ICU liberation serves patients and families. Crit Care Med. 2017;45(2):321-30. doi: 10.1097/CCM.0000000000002175.

Barnes-Daly MA, Phillips G, Ely EW. Improving hospital survival and reducing brain dysfunction at seven California community hospitals: implementing pad guidelines via the ABCDEF bundle in 6,064 patients. Crit Care Med. 2017;45:171-8. doi: 10.1097/CCM.0000000000002149.

Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, et als: Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med.2019;47:3-14. doi: 10.1097/CCM.0000000000003482.

Devlin JW, Skrobik Y, Gelinas C, Needham DM, et als: Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46:e825-73. doi: 10.1097/CCM.0000000000003299.

Celis-Rodríguez E, Díaz JC, Cárdenas YR, Carrizosa JA, Pinilla DI, Ferrer LE, et al. Guías de práctica clínica basadas en la evidencia para el manejo de la sedoanalgesia y delirium en el paciente adulto críticamente enfermo. Med Intensiva. 2020;44:171-84. doi: 10.1016/j.medin.2019.07.013.

Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107-16. doi: 10.1056/NEJMoa1005372.

Alhazzani W, Belley-Cote E, Moller MH, Angus DC, Papazian L, Arabi YM, et al. Neuromuscular blockade in patients with ARDS: a rapid practice guideline. Intensive Care Med. 2020;46:1977-86. doi: 10.1007/s00134-020-06227-8.

Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc. 2017;14(4):S280-8. doi: 10.1513/AnnalsATS.201704-343OT.

Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-68. doi: 10.1056/NEJMoa1214103.

Sud S, Friedrich JO, Adhikari NK, Taccone P, Mancebo J, Polli F, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Can Med Assoc J. 2014;186(10):E381-90. doi: 10.1503/cmaj.140081.

Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev. 2015;2015(11):CD008095. doi: 10.1002/14651858.CD008095.pub2.

Lamb CR, Desai NR, Angel L, Chaddha U, Sachdeva A, Sethi S, et al. Use of tracheostomy during the COVID-19 pandemic: CHEST/AABIP/AIPPD: Expert Panel Report. CHEST. 2020;158(4):1499-514. doi: 10.1016/j.chest.2020.05.571.

McGrath BA, Brenner MJ, Warrillow SJ, Pandian V, Arora A, Cameron TS, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med. 2020;8(7):717-25. doi: 10.1016/S2213-2600(20)30230-7.

Singer BD, Jain M, Budinger GRX, Wunderink RG. A call for rational intensive care in the era of COVID-19. AJRCMB. 2020;63(1). doi: 10.1165/rcmb.2020-0151LE.

Warwicker P. Polio: the story of the great polio epidemic in Copenhagen in 1952. Copenhagen, Denmark: Gyldendal; 2006.

Gensowski M, Nielsen TH, Nielsen NM, Rosin-Slater M, Wüstk M. Childhood health shocks, comparative advantage, and long-term outcomes: evidence from the last Danish polio epidemic. J Health Econom. 2019;66:27-36. doi: 10.1016/j.jhealeco.2019.03.010.

Bellani G, Laffey JG, Pham T, Madotto F, Fan E, Brochard L, et al. Noninvasive ventilation of patients with acute respiratory distress syndrome: insights from the LUNG SAFE study. Am J Respir Crit Care Med. 2017;195:67-77. doi: 10.1164/rccm.201606-1306OC.

Mehta AB, Douglas IS, Walkey AJ. Evidence-based utilization of noninvasive ventilation and patient outcomes. Ann Am Thorac Soc. 2017;14:1667-73. doi: 10.1513/AnnalsATS.201703-208OC.